Comparison of fluoroscopy-guided Pull-type percutaneous radiological gastrostomy (Pull-type-PRG) with conventional percutaneous radiological gastrostomy (Push-type-PRG): clinical results in 253 patients.

OBJECTIVES: To analyze the clinical results and complications of fluoroscopy guided internal-external Pull-type percutaneous radiological gastrostomy (Pull-type-PRG) and conventional external-internal percutaneous radiological gastrostomy (Push-type-PRG). METHODS: A total of 253 patients underwent radiological gastrostomy between January 2002 and January 2010. Data were collected retrospectively from radiology reports, Chart review of clinical notes, procedure reports, discharge summaries and subsequent hospital visits. Statistical analysis was performed to compare the two methods for gastrostomy with respect to peri-interventional aspects and clinical results. RESULTS: 128 patients received the Pull-type-PRG whereas the other 125 patients were served with the Push-type-PRG. Indications for gastrostomy were similar in these two groups. The most frequent indications for the both methods were stenotic oesophageal tumors or head/neck tumors (54.7% in Pull-type-PRG, 68% in Push-type-PRG). Gastrostomy procedures were successful in 98.3% in Pull-type-PRG compared to 92% in Push-type-PRG. There was no procedure-related mortality. Compared to Push-type-PRG, the peri-interventional complication rate was significantly reduced in Pull-type-PRG (14.8% versus 34.4%, P = 0.002). CONCLUSIONS: Compared to the external-internal Push-type-PRG, the internal-external Pull-type-PRG showed a high primary success rate and a decreased incidence of peri-interventional complications.

Bone mineral density and vitamin D status in female and male patients with osteoarthritis of the knee or hip.

OBJECTIVE: Osteoporosis (OP), osteoarthritis (OA) and vitamin D deficiency are age-related disorders. We investigated the association between bone mineral density (BMD), vitamin D and OA in patients undergoing total hip or knee replacements. METHOD: In total, 82 women and 35 men with mean ages of 70 and 68 years, respectively, were recruited for the study. The BMD of the lumbar spine and the proximal femur were measured by dual-energy X-ray absorptiometry. The vitamin D status was assessed by 25(OH)D levels, with a cut-off of

[Single center experience over a 5-year period with sequential transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC)]. / Sequentielle transarterielle Chemoembolisation (TACE) des hepatozellulären Karzinoms (HCC)--Erfahrungsbericht eines einzelnen Zentrums über 5 Jahre.

PURPOSE: To analyze the course of disease of patients treated with sequential TACE and to evaluate the dependent and independent prognostic factors for patient survival using the Cox Proportional Hazard Model. MATERIALS AND METHODS: 94 patients palliatively treated with TACE. Patients were selected if they had been treated at least 3 times. The TACE procedure was carried out at 8-week intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10 ml Lipiodol. Follow-up investigations included contrast-enhanced multislice CT before and after TACE and assessment of the laboratory test results (i. e., blood count, liver enzymes, and coagulation). RESULTS: In 66.7 % of the patients, multifocal tumors were found. In 16.0 % of the patients, the tumor load represented more then 50 % of the liver volume. In 23.4 % of the cases, a portal vein thrombosis was found in the initial CT scan. The mean survival for the total cohort was 24.1 months (95 %-CI 20.1 - 28.2). During the investigation period, 72/94 of the patients died. The cumulative 1-year, 2-year, and 3-year survival rates are 71.6 %, 33.9 %, und 17.2 %, respectively. A median of 6.0 +/- 3.1 (range 14, n total = 612 TACE) was performed in each patient. A total of 62.5 % patients died because of tumor progression whereas 18.1 % died due to progressive liver failure. Patients in whom the tumor responded to the TACE treatment and who did not develop ascites or those with Okuda stage I or unifocal tumor growth showed a survival benefit whereas the presence of portal vein thrombosis was associated with a significantly poor outcome (p < 0.05). The Child-Pugh stage was not statistically significant for the disease course; the occurrence of new tumor lesions had no influence with regard to 1-year and 2-year survival but had a significant influence on long-term survival (p < 0.05). Independent prognostic factors are (multivariate analysis; p < 0.05): number of TACE performed, tumor type (i. e., unifocal vs. multifocal), response to TACE (response vs. progression), and Okuda stage. CONCLUSION: Our results emphasize the value of TACE in the palliative treatment of HCC. Under sequential TACE therapy the course of disease in patients suffering from portal vein thrombosis was not significantly worse. Crucial prognostic factors for the course of the HCC are tumor type and extension, response to TACE, and liver function at the beginning of TACE.

[Classification and treatment of endoleaks after endovascular treatment of abdominal aortic aneurysms]. / Klassifikation und Therapie von Endolecks nach endovaskulärer Behandlung von abdominellen Aortenaneurysmen.

This article describes the classification of endoleaks after endovascular treatment of abdominal aortic aneurysms, thereby summarizing the most important problems of this endovascular technique. The correct classification of endoleaks is a prerequisite for interdisciplinary discussion. It is indispensable for professional reporting of the pathological findings and for the decision making as to the adequate treatment of endoleaks. Irrespective of the types of stent graft and property of the material, five endoleak types are defined in the literature: leakage at the anchor sites (type I); leakage due to collateral arteries (type II); defective stent grafts (type III); leakage due to porosity of the graft material (type IV); and endotension (type V). The causes of endoleaks are discussed and treatment options are reviewed for the diverse pathologic findings.

[TACE: therapy of the HCC before liver transplantation--experiences]. / TACE: Therapie des HCC vor Lebertransplantation -- Erfahrungen.

PURPOSE: Analysis of the course of disease in patients with histologically proven HCC before and after orthotopic liver transplantation (LTx) who received transarterial chemoembolization (TACE). MATERIAL AND METHODS: Thirty-five of a total collective of 363 patients with histologically proven HCC underwent LTx. Before LTx, all patients were treated with sequential TACE. According to treatment pattern, TACE should be performed every 6 weeks, using a suspension consisting of max. 10 mg Mitomycin C as well as 10 - 30 ml iodized oil (Lipiodol). Patients were classified according to the Milano criteria. Criteria were called exceeded if the tumor size was > 5 cm and/or > 3 tumors larger than 3 cm were found. Therapy success and liver function were examined by means of spiral CT and laboratory controls. Investigation parameters included the number of tumor knots as well as the maximum tumor size. Additionally, the Lipiodol accumulation, the patency of the portal vein and the occurrence of complications were checked. RESULTS: Altogether, 184 TACE procedures were accomplished (5.3 +/- 3.3, range 1 - 14). The waiting period up to the transplantation amounted to 366 +/- 255 days (range 44 - 1137). The average number of tumor knots for each patient was 3.1 +/- 2.2 before and 2.9 +/- 2.2 after TACE (p = 0.887). The average tumor size was 4.2 +/- 2.5 before and 2.8 +/- 1.4 after TACE. The Milano criteria to LTx crossed 17/35 patients. Patients with exceeded Milan criteria showed a highly significant size reduction of the tumor after TACE (p = 0.001); in 9/17 cases the transplantation criteria were secondarily fulfilled through downstaging. A successful LTx was accomplished in 35/35 cases. Follow up after LTx was 769 +/- 509 days. The tumor recurrence in patients with exceeded vs. fulfilled transplantation criteria was 11.1 % vs. 11.8 % (p = 0.99). The recurrence free survival was 93.3 %, 82.5 % and 82.5 % at 1, 3 and 5 years, respectively. There were no relevant differences between patients with exceeded vs. fulfilled transplantation criteria (p = 0.99). CONCLUSION: The sequential TACE is an effective method for the therapy of the HCC before LTx in selected patients. A relevant downsizing could be achieved by TACE in patients with advanced HCC. Patients with larger tumors showed a significantly stronger size reduction after TACE. The recurrence rate and the survival rate for patients with advanced or small tumors do not differ.

Chemoembolization for primary liver cancer.

AIMS: For most patients with primary liver cancer surgical treatment is not feasible and prognosis without treatment is poor. We aimed to assess the morbidity and efficacy of transarterial chemoembolization (TACE) with lipiodol and mitomycin C in these patients in a prospective case-control study. METHODS: From August 1996 to May 2000 22 patients with non-resectable hepatocellular carcinoma were treated with TACE. In case of radiological or tumour-marker response, treatment was repeated after 4--6 weeks, up to seven times per patient. RESULTS: Morbidity was 23% and usually minor, no patient died within 30 days of treatment. A decrease in size of the reference tumour or constant tumour-size in CT-scan were observed in 14 of 20 patients (70%) and of the 19 patients with elevated AFP-serum levels 12 (63%) had an AFP reduction following treatment. The median survival time was 14 months with a 1- and 2-year survival rate of 69% and 29%, respectively. Survival was not different in radiological or AFP responders vs non-responders. CONCLUSION: While TACE with lipiodol and mitomycin C for primary liver cancer is associated with considerable antitumoural efficacy, as demonstrated by tumour marker and radiological response, an effect on patient survival is not evident. New treatment options with an impact on survival are needed for these patients.

Endovascular treatment of acute bleeding complications in traumatic aortic rupture and aortobronchial fistula.

OBJECTIVE: Herein we report our experience in placement of endovascular stentgrafts in the descending aorta in patients with acute bleeding complications due to traumatic rupture or aortobronchial fistula. METHODS: Six patients (one woman, five men, mean age 47+/-19 years) were treated from September 1995 to February 2000 by implantation of endovascular stentgrafts in the descending aorta. Indications included traumatic ruptures of the aortic isthmus (n=3) and aortobronchial fistulas (n=3). All procedures were performed under general anaesthesia. The implants were introduced under fluoroscopic guidance via the aorta (n=1), the iliac (n=4) or femoral (n=2) artery, respectively. RESULTS: All aortobronchial fistulas and ruptures were sealed up successfully. There was no perioperative morbidity and no procedure-related morbidity except one patient who received aortofemoral reconstruction because of iliac occlusive disease. All patients are alive and well after a mean follow-up of 31 months (range 6-60). Two patients had recurrent hemoptysis, in one case, the patient received a second implant (distal extension), the other patient was managed conservatively. CONCLUSION: Endovascular treatment by a stentgraft is a safe and reliable procedure in the management of acute bleeding complications in patients with aortic rupture or aortobronchial fistulas.

[Therapy of thromboembolic blockages in the crural arteries: Clinical experience with the Angiojet thrombectomy catheter]. / Therapie thrombembolischer Verschlüsse der Unterschenkelarterien: Klinische Erfahrungen mit dem Angiojet-Thrombektomiekatheter.

UNLABELLED: To investigate the clinical impact of a new hydrodynamic thrombectomy catheter in thromboembolic occlusion of tibial arteries. METHOD: 10 patients with thromboembolic occlusion of all tibial arteries were treated with the Angiojet thrombectomy device in order to reestablish blood flow. Depending on angiographic and clinical results of thrombectomy, additional thrombolysis, PTA, recanalization, or surgical bypass grafting was performed. RESULTS: Antegrade blood flow in at least one tibial artery was reestablished in 6 cases with the thrombectomy device. However, additional treatment modalities were used in order to improve the outcome and to resolve adherent thrombi or to treat vessel stenoses and occlusions: thrombolysis (n = 9), PTA (n = 3), recanalization (n = 1), bypass grafting (n = 3), suction thromboembolectomy (n = 1), replacement of popliteal aneurysm (n = 1). The limb salvage rate was 7/10. The ratio of injected volume to aspiration volume was 1.04 +/- 0.07 indicating that the system works isovolumetrically. The device induced moderate hemolysis with plasma free hemoglobin rising by the factor 12.91 +/- 11.59, (P < 0.01). CONCLUSION: In cases with thromboembolic occlusions of tibial arteries the Angiojet thrombectomy catheter is a valuable addition to the interventional instrumentarium. It works isovolumetrically but induces moderate hemolysis and thereby may compromise renal function. However, in most cases additional treatment modalities are required.

[MR tomographic measurement of the diastolic relaxation of the hypertrophied left ventricle with the single-slice-multiphase technic]. / MR-tomographische Messung der diastolischen Relaxation hypertrophierter linker Ventrikel mit Single-slice-multi-phase-Technik.

In order to assess diastolic ventricular function in hypertensive patients, a single-slice multiphase sequence was used in order to measure contraction and early diastolic relaxation. There was no difference in the contraction velocity between hypertensives and normals (Vsys. n.r. = 56.1 +/- 13.8% LVDV/s vs. 51.7 +/- 8.6% LVEDV/s, stat, n. sign.). Early diastolic relaxation velocity in hypertensives was reduced as compared with the control group (Vdiast. 1n.r. = 37.9 +/- 13.1% LVEDV/s vs. 47.1 +/- 9.6% LVEDV/s, p < 0.05). There was no linear relation between abnormal relaxation and the extent of myocardial hypertrophy. Hypertensives with myocardial hypertrophy frequently had reduced early diastolic relaxation velocity. Regression analysis for estimating left ventricular volumes derived from single-slice measurements were confirmed by additional multislice measurements. The calculated LVEDV correlated at r = 0.956 with multi-slice measurements and tended to show lower values (LVEDV n.r. = 104.6 +/- 30.8 ml vs. LVEDV = 102.1 +/- 28.8 ml, r = 0.956, p < 0.05). The LVESV was overestimated by the multi-slice technique, the calculated regression volume averaged 23% lower, realistic values (LVESV n.r. = 28.5 +/- 15.3 ml vs. LVESV = 37.1 +/- 15.6 ml, r = 0.887, p < 0.001).

[Effect of oxygen inhalation on hemodynamics in chronic thromboembolic pulmonary hypertension]. / Auswirkungen der Sauerstoffinhalation auf die Hämodynamik bei chronischer thromboembolischer pulmonaler Hypertonie.

PURPOSE: This study evaluates the haemodynamic effects of oxygen inhalation on pulmonary artery pressure and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. METHOD: In 47 patients with chronic thromboembolic pulmonary hypertension haemodynamic parameters were measured before and after oxygen inhalation. RESULTS: In moderately severe and severe pulmonary hypertension oxygen inhalation significantly reduced mean pulmonary artery pressure by about 11.1% and 4.6%, respectively. However, pulmonary vascular resistance was not significantly affected. Oxygen saturation improved and heart rate was reduced. Cardiac index decreased in severe pulmonary hypertension. Systemic vascular resistance increased. CONCLUSION: We conclude that oxygen inhalation reduces pulmonary artery pressure and improves oxygen supply in patients with moderately severe and severe chronic thromboembolic pulmonary hypertension.

[Chronic thromboembolic pulmonary hypertension: hemodynamic effects of selective pulmonary artery DSA with nonionic contrast media]. / Chronische thromboembolische pulmonale Hypertonie: Hämodynamische Auswirkungen der selektiven Pulmonalis-DSA mit nicht-ionischem Kontrastmittel.

PURPOSE: This study evaluates the effects of pulmonary bolus injection of nonionic contrast medium on pulmonary artery pressure and resistance in patients with chronic thromboembolic pulmonary hypertension. METHODS: In 39 patients (age 52 +/- 15) haemodynamic measurements were performed during bolus injection of nonionic contrast medium in a control group (I), in moderately severe (II) and severe pulmonary hypertension (III). RESULTS: Initial inspiratory arrest caused significant pressure increase in all groups prior to bolus injection (delta PAsyst: 7.1 +/- 6.7 [I], 6.8 +/- 3.9 [II] und 7.2 +/- 7.9 mmHg p < 0.05). However, contrast bolus injection (25.1 +/- 2.3 ml iopamidol, 13.0 ml/s) caused only minor additional pressure increase (delta PAsyst: 2.2 +/- 1.4 [I], 2.7 +/- 1.9 [II] und 4.9 +/- 5.4 mmHg [III] p < 0.05). After angiography pulmonary artery pressure and vascular resistance was increased only moderately, predominantly in group III. Systemic vascular resistance was slightly decreased. CONCLUSION: In patients with moderately severe and severe chronic thromboembolic pulmonary hypertension bolus injection of nonionic contrast medium causes no major haemodynamic effects.

Pulmonary balloon angioplasty of chronic thromboembolic pulmonary hypertension (CTEPH) in surgically inaccessible cases.

The clinical course of patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) depends on the distribution pattern of the thromboembolic material. In patients with thromboembolic findings in the central pulmonary segments pulmonary thrombendarterectomy (PTE) has excellent results and acceptable operative risk. This paper presents two surgically inaccessible cases that were successfully treated with balloon pulmonary angioplasty. Balloon angioplasty improved parenchymal perfusion, increased cardiac index (Delta CI +19.2 % [Case 1], and +15.4 % [2]), reduced pulmonary vascular resistance during follow-up (Delta PVRI -25.0 % [1] and -15.9 % [2]), and is discussed as an alternative treatment option for cases not suited for surgery.

[Chronic thromboembolic pulmonary hypertension: diagnostic impact of Multislice-CT and selective Pulmonary-DSA]. / Chronische thromboembolische pulmonale Hypertonie: Diagnostische Wertigkeit von Mehrschicht-CT und selektiver Pulmonalis-DSA.

PURPOSE: To evaluate the diagnostic impact of multislice-CT and selective pulmonary DSA in chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: 994 vessel segments of 14 consecutive patients with CTEPH were investigated with multislice-CT (slice thickness 3 mm, collimation 2.5 mm, reconstruction intervall 2 mm) and selective pulmonary DSA (posterior-anterior, 45 degrees oblique, and lateral projection. Analysis was performed by 2 investigators independently for CT and DSA. Diagnostic criteria were occlusions and non-occlusive changes like webs and bands, irregularities of the vessel wall, diameter reduction and thromboembolic depositions at different levels from central pulmonary arteries to subsegmental arteries. Reference diagnosis was made by synopsis of CT and DSA by consensus. RESULTS: Concerning patency CT and DSA showed concordant findings overall in 88.9 %, 92.9 % for segmental arteries and 85.4 % for subsegmental arteries. Concerning any thromboembolic changes, multislice-CT was significantly inferior to selective DSA (concordance 67.0 % overall, 70.4 % for segments and 63.6 % for subsegments). Non-occlusive changes of the vessels were significantly underdiagnosed by CT (concordance of CT versus DSA: 23.1 %). CONCLUSION: Multislice-CT and selective pulmonary DSA are equivalent for diagnosis of vessel occlusions at the level of segmental and subsegmental arteries. However, for visualisation of the non-occlusive thromboembolic changes of the vessel wall selective pulmonary DSA is still superior compared to multislice-CT. Multislice-CT and selective pulmonary DSA are complementary tools for diagnosis and treatment planning of chronic thromboembolic pulmonary hypertension (CTEPH).

[The current value of percutaneous transhepatic biliary drainage]. / Gegenwärtiger Stellenwert der perkutanen transhepatischen Cholangiodrainage.

Percutaneous transhepatic biliary drainage (PTBD) is a well established method in the treatment of obstructive jaundice. Major indications are malignant diseases. PTBD may be necessary preoperatively in cases with severe jaundice or cholangitis or as part of palliative treatment concepts. In the past, it has been proposed that a period of preoperative PTBD may improve the morbidity rates of surgery. Various studies could not prove this theory. The significance of preoperative PTBD has changed, as observed during a 15 years period in our own institution, the indications for preoperative PTBD have decreased by half. At present, the majority of treatments with PTBD are palliative (almost 70 % of all procedures). The diagnostic opportunities of the transhepatic approach (intraductal sonography, cholangioscopy, biopsy) are exploited only in few selected cases. Since the radiological approach ist considered to be invasive and related to serious complications most patients are being referred to endoscopic drainage first. Radiologists are consulted in complicated cases of jaundice and when endoscopic approaches have failed. The retrospective evaluation of more than 1000 procedures over a period of 16 years demonstrates good results with a low rate of serious complications. During the two observed periods of nine and seven years, respectively, there occurred complications like sepsis in 1.9 %/0.5 %, peritonitis in 0.5 %/0.7 %, severe bleeding in 0.5 %/1.5 %, procedure-related death in 0.8 %/0.7 %. The overall rate of serious complications was 5 %/3.4 %. These results are comparable to those of the endoscopic approach with a complication rate of 3.6-14 % and a mortality rate of 0.5 %.

[MR tomographic functional analysis of the left ventricle]. / MR-tomographische Funktionsanalyse des linken Ventrikels.

The following contribution presents a continuous MRT analysis of the contraction and relaxation processes of healthy left ventricles giving reference values for contraction and relaxation velocities. For the total ventricle we have Vsyst. r. total = 342 +/- 47% LVEDV/sec and Vdiast. r. total = 303 +/- 59% LVEDV/sec. In relation to the end-diastolic (tomographic) volume (EDSV) significantly greater changes in volume per unit of time were measured apically compared to basal (systolic: 411 +/- 89% EDSV/sec apical vs 261 +/- 35% EDSV/sec basal; diastolic: 810 +/- 145% EDSV/sec apical vs 245 +/- 70% EDSV/sec basal). Occurrence of the end-systolic minimal volumes of apical tomographic layers was delayed against the total ventricle by 22.4 +/- 7.9% t syst. Within the ventricle there was systolically a redistribution of the proportions of volume from apical to basal.

[Emergency endovascular treatment of acute aortic diseases]. / Endovaskuläre Behandlung akuter Erkrankungender thorakalen Aorta.

PURPOSE: To investigate the safety and efficacy of emergency treatment of acute aortic diseases with endovascular stent grafts. METHODS: In 11 patients (median age 55 years, range 18 - 85) with acute complications of descending aortic diseases endovascular emergency treatment was performed: traumatic aortic rupture (n = 4), penetrating ulcer with aortobronchial fistula or hematothorax (n = 4), acute type B dissection (n = 2, one with penetration, one with subacute mesenteric ischemia), and symptomatic aneurysm of the thoracic aorta (n = 1) with pain and diameter progression. 15 stent grafts were implanted (Talent n = 11, Vanguard/Stentor n = 4). Stent extension was necessary in 4 cases. In 2 cases graft extension was done during the first procedure (due to distal migration and due to the total length of the aortic aneurysm). In 2 cases graft extension was performed 5 days (due to a new aortic ulcer at the proximal stent struts) and 5 months after the initial procedure (recurrent aortobronchial fistula due to aneurysm progression). 14 of 15 implantations required general anesthesia, one symptomatic thoracic aneurysm was performed in local anesthesia and sedation. RESULTS: 14 of 15 graft procedures were performed using the femoral or iliac approach. One procedure required aortofemoral bypass grafting due to extensive arteriosclerotic stenosis and the stent graft was inserted via the bypass graft. The orifice of the subclavian artery was crossed with bare stent struts in 4 cases without neurological complications. Median follow-up is 27 months (range 6 to 72 months). In traumatic aortic ruptures, immediate sealing of bleeding was achieved and follow-up is inconspicuous at a maximum of 72 months. In cases of aortobronchial fistulas, follow-up is satisfactory (maximum 72 months) despite the necessity for reintervention and graft extension. In one acute type B dissection retrograde dissection of the aortic arch occurred during stent release with stable disease during follow-up without neurological complications. In one type B dissection with mesenteric ischemia the mesenteric blood flow was restored. A second look operation confirmed pulsatile flow in the mesenteric trunk but a total necrosis of the small intestine and the patient consequently died. CONCLUSION: Endovascular treatment is safe and effective for emergency treatment of life-threatening complications in selected acute aortic syndromes. Mid-term results are encouraging, however, regular follow-up is mandatory to recognize late complications of the stent graft.

[Influence of endoleaks on aneurysm volume and hemodynamics after endovascular aneurysm repair]. / Einfluss von Typ-II-Endoleaks auf die Grössenänderung und Hämodynamik experimenteller Aortenaneurysmen nach endovaskulärer Therapie.

PURPOSE: To evaluate the aneurysm volume and the intra-aneurysmatic pressure and maximal pressure pulse (dp/dtmax) in completely excluded aneurysms and cases with endoleaks. MATERIALS AND METHODS: In 36 mongrel dogs, experimental autologous aneurysms were treated with stent-grafts. All aortic side branches were ligated in 18 cases (group I) but were preserved in group II (n = 18). Aneurysm volumes were calculated from CT scans before and after intervention, and from follow-up CT scans at 1 week, 6 weeks and 6 months. Finally, for hemodynamic measurements, manometer-tipped catheters were introduced into the excluded aneurysm sac (group I and II), selectively in endoleaks (group II), and intraluminally for aortic reference measurement. Systemic hypertension was induced by volume load and pharmacologic stress. Pressure curves and dp/dt were simultaneously recorded and the ratios of aneurysm pressure to systemic reference pressure calculated. RESULTS: At follow-up, type-II. endoleaks were excluded in all cases of group I by selective angiography. In contrast, endoleaks were evident in all cases of group II. Volumetric analysis of the aneurysms showed a benefit for group I with an improved aneurysm shrinkage: DeltaVolume + 0.08 %, - 1.62 % and -9.76 % at 1 week, 6 weeks and 6 months follow-up (median, group I), compared to + 1.43 %, + 0.67 %, and - 4.04 % (group II), p < 0.05. In case of complete aneurysm exclusion the ratio of systolic aneurysm pressure to systemic reference pressure was 0.662, 0.575 and 0.385 (median) at 1 week, 6 weeks and 6 months. The corresponding dp/dtmax ratios were 0.12, 0.07 and 0.04, respectively. However, within endoleaks selective measurements showed significantly increased pressure load: the ratios of systolic endoleak pressure to systemic reference pressure and the corresponding ratios for dp/dtmax were 0.882 and 0.913 (median), respectively. These hemodynamic findings were linear from hypotension, physiologic blood pressure to hypertension. CONCLUSION: Occlusion of all aortic side branches of an aneurysm prior to stent-grafting reduces endoleaks and promotes aneurysm shrinkage. Complete aneurysm exclusion significantly reduces systolic pressure and dp/dt max. In contrast, endoleaks showed nearly systemic pressure load and undamped pulsatility.

[Measurement error estimation in MR tomographic volumetry of the left ventricle with the multisection technic]. / Messfehlerschätzung bei der MR-tomographischen Volumetrie des linken Ventrikels mit Mehrschicht-Technik.

A multi-slice technique for MRT measurements of the left ventricular volume is much faster than the use of single-slice methods and is therefore better tolerated, leaving time for additional measurements. The end-diastolic left ventricular volume can be reliably measured by this method (123.3 +/- 13.5 ml vs. 124.1 +/- ml). The end-systolic volume is consistently overestimated by 23.7 +/- 18.3% compared with the reference value obtained by single slice measurements (47.9 +/- 8.9 ml vs 39.1 +/- 7.9 ml). Correspondingly, stroke volume and ejection fraction is underestimated on average by 10.6 +/- 9.7% and 10.6 +/- 7.6% respectively).

[Endovascular therapy of abdominal aortic aneurysm: results of a mid-term follow-up]. / Endovaskuläre Therapie von abdominellen Aortenaneurysmen: Klinisch-radiologische Ergebnisse im mittelfristigen Verlauf.

PURPOSE: Prospective study to evaluate clinical results and complications of endovascular abdominal aortic aneurysm treatment in a mid-term follow-up. MATERIALS AND METHODS: A total of 122 patients (9 females, 113 males, average age 70.9 +/- 7.9 years) with abdominal aortic aneurysms were treated with stent grafts (53 Vanguard or Stentor endografts, 69 Talent endografts). Group I consisted of 40 patients who had all aortic tributaries of the aneurysm sac occluded prior to endovascular grafting, either spontaneously by parietal thrombosis or by selective coil embolization of the respective ostia preserving collateral circulation distal to the vessel occlusion. Group II consisted of 82 patients and included all cases without or with incomplete coil embolization with at least one patent vessel. Stent grafting was performed in general anesthesia in the first 21 patients, followed by peridural anesthesia in 15 cases, and local anesthesia with conscious sedation in 86 cases. The results were evaluated with Spiral-CT, MRI and radiographs of the endovascular graft, with follow-up examinations obtained at 3, 6, 12 months, and every year. RESULTS: Implantation was successfully completed in all cases without primary conversion surgery, laparotomy, or any significant complication. Mean follow-up was 29 +/- 21 months (maximum 84 months). The 30-day mortality was 0.8 % due to a myocardial infarction 3 days after discharge from the hospital. A total of 47 re-interventions were performed in 29 patients (23.8 %), with 35 re-interventions in 18 cases with Vanguard or Stentor endografts and 12 re-interventions in 11 patients with Talent endografts. 23 percutaneous re-interventions included distal graft extension (n = 11), Wallstents for kinking and limb stenosis (n = 3), and secondary coil embolization of collateral vessels (n = 9). 24 surgical re-interventions included proximal graft extension (n = 6), new endovascular grafts (n = 3), surgical clipping of lumbar and mesenteric artery branches for type-II endoleaks following ineffective secondary coil embolization (n = 1), and femorofemoral crossover bypasses (n = 4). A total of 10 secondary conversion operations were performed because of damage to the membrane (n = 4; 3 Vanguard endografts, 1 Talent endograft), significant caudal migrations (n = 5; 4 Vanguard endografts, 1 Talent endograft) associated with type-I endoleaks (n = 2), limb occlusion (n = 1), disconnection of graft components (n = 1), and significant endoluminal thrombus deposits (n = 1). One patient, who was followed for 82 months, suffered from a significant endoleak for 10 months with increasing aneurysm diameter but he refused surgery. He was admitted with aneurysm perforation and was successfully operated with aortic graft replacement. Compared to group II, the incidence and size of endoleaks was reduced in group I (incidence 19.2 % versus 29.9 %, p < 0.05). Group I demonstrated significantly better aneurysm shrinkage at 36 months follow-up (Delta sagittal diameter - 11.1 +/- 8.4 mm versus - 4.9 +/- 6.2 mm, p < 0.05). CONCLUSION: In selected patients, endovascular aneurysm treatment is an effective alternative to open surgery. It is safely performed in local anesthesia with low mortality rate and a low number of acute complications. Intermediate follow-up revealed re-interventions in around one quarer of all patients, especially when Vanguard or Stentor endografts were implanted. Primary coil embolization of all aortic branches prior to endovascular grafting improves clinical outcome. Insufficient proximal fixation and its consecutive complications remains a major problem of this method.

[Indirect MR-arthrography in the follow up of autologous osteochondral transplantation]. / Indirekte MR-Arthrographie zur Verlaufskontrolle nach autologer osteochondraler Transplantation.

PURPOSE: To evaluate the spectrum of findings in indirect MR-arthrography following autologous osteochondral transplantation. PATIENTS AND METHODS: 10 patients with autogenous osteochondral homografts underwent indirect MR-arthrography at three, 6 and 12 months postoperatively. The MR protocol at 1.5 T comprised unenhanced imagings with PD- and T2 -weighted TSE- sequences with and without fat-suppression as well as T1 -weighted fat-suppressed SE-sequences before and after i.v. contrast administration and after active joint exercise. Image analysis was done by two radiologists in conference and comprised the evaluation of signal intensity (Sl) and integrity of the osseous plug and the cartilage surface, as well as the presence of joint effusion or bone marrow edema. RESULTS: At three months, all cases demonstrated a significant bone marrow edema at the recipient and donor site that corresponded to a significant enhancement after i.v. contrast administration. The interface between the transplant and the normal bone showed an increased Sl at three and 6 months in T2 -weighted images as well as in indirect MR-arthrography. The marrow signal normalized in most cases after 6 to 12 months, indicating vitality and healing of the transplanted osteochondral graft. The Sl of the interface decreased in the same period, demonstrating the stability of the homograft at the recipient site. The osteochondral plugs were well-seated in 9/10 cases. Indirect MR-arthrography was superior to unenhanced imaging in the assessment of the cartilage surface. Cartilage coverage was complete in every case. The transplanted hyaline cartilage as well as the original cartilage showed a significant increase of the Sl in indirect MR-arthrography, that did not change in follow up studies. There were no pathological alterations of signal and thickness alterations of the transplanted cartilage in follow up investigations. CONCLUSION: Indirect MR-arthrography is a useful diagnostic tool following autologous osteochondral transplantation. Assessment of transplant vitality, osseous fixation and stability is possible.